Lyndal Trevena

The University of Sydney · School of Public Health

Background: A risk-stratified approach to colorectal cancer (CRC) screening could result in more acceptable balance of benefits and harms and be more cost-effective. Aim: To determine the effect of a consultation in general practice using a computerised risk assessment and decision support tool (CRISP) on risk-appropriate CRC screening. Design and...

Introduction: This cluster-randomized controlled trial aimed to assess the effect of the "Which test is best?" tool on risk-appropriate screening (RAS) and colorectal cancer (CRC) screening uptake. Methods: General practices in Sydney and Melbourne, Australia, and a random sub-sample of 460 patients (aged 25-74 years) per practice were invited b...

Objective: "Biological age" calculators are widely used as a way of communicating health risk. This study evaluated the behaviour change techniques (BCTs) within such tools, underlying algorithm differences, and suitability for people with varying health literacy. Methods: Two authors entered terms into Google (e.g. biological/heart age) and rec...

Background and objectives: Primary healthcare practitioners (PHPs) are often the first point of care for people seeking refuge or asylum in Australia. Communication plays a vital part in their care. The aim of this study was to identify, appraise and synthesise online resources that aim to support communication during consultations with these pati...

Objective This study aimed to explore the perceived acceptability, usefulness, and feasibility of a suite of encounter decision aids (DAs) with Chinese migrant women living in Australia and healthcare providers. Methods Semi-structured in-depth interviews with 22 Chinese migrant women and twenty healthcare providers were conducted. Transcribed dat...

Background Refugees and asylum seekers arrive in the Australian community with complex health needs and expectations of healthcare systems formed from elsewhere. Navigating the primary healthcare system can be challenging with communication and language barriers. In multicultural societies, this obstacle may be removed by accessing language-concord...

Background Since the inception of PHNs in Australia, their role in implementing chronic disease prevention activities in general practice has been unclear. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention. Methods Content analysis o...

BACKGROUND Shared decision making is as an essential principle for cardiovascular disease (CVD) prevention, where asymptomatic people are considering lifelong medication and lifestyle changes. OBJECTIVE This project aimed to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health lite...

Background: Shared decision-making is an essential principle for the prevention of cardiovascular disease (CVD), where asymptomatic people consider lifelong medication and lifestyle changes. Objective: This study aims to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health litera...

Limited studies at the beginning of the COVID-19 pandemic found GPs have been negatively affected by increased workload, reduced income and major concerns about staff and patient safety. This study aimed to investigate the challenges of COVID-19 in general practice 1 year since it was declared a pandemic. A national cross-sectional online survey wa...

Introduction: Shared decision making is as an essential principle for cardiovascular disease (CVD) prevention, where asymptomatic people are considering lifelong medication and lifestyle changes. This project aimed to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, an...

Background Effective implementation requires a comprehensive understanding of individual, organisational and system determinants. This study aimed to compare inductive and deductive analysis techniques to understand a complex implementation issue. We used childhood vaccination as a case study, an issue with wide-ranging barriers contributing to low...

Introduction Understanding barriers to childhood vaccination is crucial to inform effective interventions for maximising uptake. Published systematic reviews include different primary studies, producing varying lists of barriers. To make sense of this diverse body of literature, a comprehensive level of summary and synthesis is necessary. This over...

Purpose We evaluated the impact of personal melanoma genomic risk information on sun-related behaviors and psychological outcomes. Methods In this parallel group, open, randomized controlled trial, 1,025 Australians of European ancestry without melanoma and aged 18–69 years were recruited via the Medicare database (3% consent). Participants were r...

Background The Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice (the Guideline) was published in 2019. The objective of this trial is to implement the Guideline in general practice. Trial design Implementing work-related Mental health conditions in general PRacticE is a hybrid III, pa...

Background: Since the inception of Primary Health Networks (PHNs) in Australia, it has been unclear what their role is regarding implementing chronic disease prevention activities in general practice. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease...

Background Australian guidelines recommend that all people aged 50–70 years old actively consider taking daily low-dose aspirin (100–300 mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical pra...

Objective: The primary aim of this study was to evaluate the agreement between surgeons and two validated total knee arthroplasty (TKA) appropriateness tools, and secondarily to compare Australian appropriateness rates to those reported internationally. Methods: A consecutive sample of patients from one public hospital arthroplasty clinic and a...

Objectives: There is a paucity of evidence on how to facilitate shared decision-making under real-world conditions and, in particular, whether interventions should target patients, health care providers, or both groups. Our objectives were to assess the comparative effectiveness, feasibility, and acceptability of patient- and provider-targeted inte...

BACKGROUND Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where doctors find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to ‘heart age’ is increasingly used to promote lifestyle change in a more intuitive way, but a rapid review...

Background Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where physicians find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to heart age is increasingly used to promote lifestyle change, but a rapid review of biological age inter...

Background Despite the development of theory-driven frameworks to guide implementation strategies, their application thus far has largely been limited to evaluating effectiveness within specific contexts. This study describes the use of these frameworks to inform a scale-up strategy for shared decision making (SDM) implementation across a state-wid...

Background: Australian guidelines recommend that all people aged 50-70 years old actively consider taking daily low-dose aspirin (100–300mg per day) for 2.5 to 5 years to reduce their risk of colorectal cancer (CRC). Despite the change of national CRC prevention guidelines, there has been no active implementation of the guidelines into clinical pra...

Background: Knee arthroplasty is a high-risk, resource-intensive procedure that should be reserved for patients in whom the benefit will outweigh the risks. The provision of high-quality, publicly available decision aids can help patients to balance the benefits against the harms of treatments and to assist informed decision-making. The aim of thi...

Background Effective implementation requires a comprehensive understanding of individual, organisational and system determinants. This study aimed to compare inductive and deductive approaches to understand a complex implementation issue. We used childhood vaccination as a case study, an issue with wide-ranging barriers contributing to low vaccine...

Background In Australia, ethnic Chinese people are one of the largest, youngest and fastest growing overseas-born groups. Yet, little is known about their perceptions of contraceptive methods and their experiences with choosing one. Decisions about contraceptive methods are preference sensitive. Understanding the influencing factors of Chinese migr...

Background: Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. Methods: Following the 2013 review method, we assembl...

Background: Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric info...

Refugee and asylum seeker population numbers are rising in Western countries. Understanding the communication experiences, within healthcare encounters, for this population is important for providing better care and health outcomes. This review summarizes the literature on health consultation communication experiences of refugees and asylum seekers...

Background Effective implementation requires identifying and addressing behavioural barriers to uptake. This study aimed to compare data-driven and theory-driven approaches to understanding implementation issues. We used childhood vaccination coverage as a case study, with international relevance and wide-ranging barriers contributing to low vaccin...

Background Effective implementation requires identifying and addressing behavioural barriers to uptake. This study aimed to compare data-driven and theory-driven approaches to understanding implementation issues. We used childhood vaccination coverage as a case study, with international relevance and wide-ranging barriers contributing to low vaccin...

Background: In Australia, there are many culturally and linguistically diverse communities and Chinese migrants make up one of the largest. Yet, little is known about healthcare providers' (HCPs) unique experiences in providing contraceptive care for Chinese migrant women. There is minimal research into the HCPs' perceptions of challenges or oppor...

It is unclear whether information given about the benefits and risks of routine childhood vaccination during consent may cue parental vaccine hesitancy. Parents were surveyed before and after reading vaccine consent information at a public expo event in Sydney, Australia. We measured vaccine hesitancy with Parent Attitudes about Childhood Vaccine S...

Research into health literacy and shared decision-making has largely developed along parallel, but distinct lines over the past two decades. There is little evidence that the concepts and related practice have intersected except in the most functional way, for example, to simplify shared decision-making tools by improving readability scores of deci...

Introduction: The concept of heart age is increasingly used for health promotion and alongside clinical guidelines for cardiovascular disease (CVD) prevention. These tools have been used by millions of consumers around the world, and many health organisations promote them as a way of encouraging lifestyle change. However, heart age tools vary widel...

Objective: To refine communication strategies to assist clinician conversations with vaccine hesitant and declining parents as part of the Sharing Knowledge About Immunisation (SKAI) package. Methods: We recorded and analysed consultations held in two Specialist Immunisation Clinics in tertiary hospitals in Australia between consenting clinician...

This qualitative study explored GPs' experiences with pharmacist-led home medicines reviews (HMRs) and the barriers and facilitators to GPs using HMRs to optimise medicines for older people. Semi-structured interviews were conducted with 32 GPs Australia-wide. Purposeful sampling was undertaken to obtain a representative group in terms of age, gend...

Background: There is limited evidence on how to implement shared decision-making (SDM) interventions in routine practice. We conducted a qualitative study, embedded within a 2 × 2 factorial cluster randomized controlled trial, to assess the acceptability and feasibility of two interventions for facilitating SDM about contraceptive methods in prima...

The aim of this study was to identify potential implementation interventions to increase the uptake of shared decision making (SDM) in clinical practice in New South Wales (NSW) Health. The Agency for Clinical Innovation hosted a full-day SDM masterclass in May 2017 and 53 attendees completed a survey to identify barriers to implementing SDM. The T...

Background: The use of cardiovascular disease (CVD) prevention guidelines based on absolute risk assessment is poor around the world, including Australia. Behavioural barriers amongst GPs and patients include capability (e.g. difficulty communicating/understanding risk) and motivation (e.g. attitudes towards guidelines/medication). This paper outl...

Objective. To explore and compare the influences of individual-level cultural values and personal attitudinal values on the desire for medical information and self-involvement in decision making in Australia and China. Methods. A total of 288 and 291 middle-aged adults from Australia and China, respectively, completed an online survey examining cul...

Background: Shared decision-making (SDM) has been found to be significantly and positively associated with improved patient outcomes. For an SDM process to occur, patients require functional, communicative, and critical health literacy (HL) skills. Objective: This study aimed to evaluate the impact of a program to improve health literacy skills for...

Perceived knowledge gaps in general practice are not well documented but must be understood to ensure relevant and timely evidence for busy general practitioners (GPs) which reflects their diverse and changing needs. The aim of this study was to classify the types of questions submitted by Australian GPs to an evidence-based practice information se...

Background: Patients' participation in medical decision making is an important aspect of patient-centred care. However, there is often uncertainty about its applicability and feasibility in non-Western countries. Objective: To provide an overview and assessment of interventions that aimed to improve patients' participation in decision making in...

Background: Musculoskeletal conditions are leading causes of disability. Management options are plentiful, but the current evidence base suggests many are ineffective or unproven. Online decision aids can help support patients make informed health care choices. However, there are little data on the quality of online decision aids for common muscul...

Purpose: Whilst competence in evidence-based practice (EBP) is a critical skill for healthcare professionals, there is a gap in the literature in the assessment of EBP. Current frameworks in Evidence-Based Practice education cite a five-step process (Ask, Acquire, Appraise, Integrate and Evaluate) yet many existing measures of competence focus on t...

Objectives Recent guideline changes for cardiovascular disease (CVD) prevention medication have resulted in calls to implement shared decision-making rather than arbitrary treatment thresholds. Less attention has been paid to existing tools that could facilitate this. Decision aids are well-established tools that enable shared decision-making and h...

Background As part of a pilot randomised controlled trial examining the impact of personal melanoma genomic risk information on behavioural and psychosocial outcomes, GPs were sent a booklet containing their patient’s genomic risk of melanoma. Aim Using this booklet as an example of genomic risk information that might be offered on a population-le...

Background<\b>: People with a family history of major depressive disorder (MDD) or bipolar disorder (BD) report specific psychoeducational needs that are unmet by existing online interventions. This trial aimed to test whether an interactive website for people at familial risk for depression (intervention) would improve intention to adopt, or actua...

Background Many individuals with a family history of depression are concerned about their risks of developing major depressive disorder and/or bipolar disorder and the risks to their offspring. They report a range of unmet educational and psychological support needs in relation to their familial risk. Several high-quality websites delivering therap...

Background Access to information about prenatal screening is important particularly in light of new techniques such as non-invasive prenatal testing (NIPT). This study aimed to develop and examine the acceptability of a low literacy decision aid (DA) about Down syndrome screening among pregnant women with varying education levels and GPs. Methods...

Objective The study aim was to identify all freely available online diabetes risk calculators and to evaluate their suitability for patients with low health literacy. Methods Online diabetes risk calculators were identified by an environmental scan. The Patient Education Material Assessment Tool for Printable Materials was used to determine unders...

Background: In Australia, the Home Medicines Review (HMR) is a nationally-funded program, led by pharmacists to optimize medication use for older people. A Medicines Conversation Guide was developed for pharmacists to use in the context of a HMR. The Guide aims to increase patient involvement and support discussions about: general health understan...

Objectives Reducing inappropriate and harmful medicines in older people with comorbidity is a major public health issue. GPs and pharmacists play a pivotal role in optimising medicines and reducing treatment burden. This includes reviewing medicines to confirm they are (still) needed/safe and align with patient goals. Medication reviews conducted b...

Background: Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral...

Background: The authors designed the evidence-based nursing practice assessment tool (EBNPAT) to measure the competence of nurses in using the five-step evidence-based practice model: ask, acquire, appraise, apply and assess. However, they needed to assess its content validity to show it is a valid tool. Assessing the content validity of a newly d...

Background: Reducing ultraviolet radiation (UV) exposure and improving early detection may reduce melanoma incidence, mortality and health system costs. This study aims to evaluate the efficacy and cost-effectiveness of providing information on personal genomic risk of melanoma in reducing UV exposure at 12 months, according to low and high tradit...

Background: Patients with complex multimorbidity often experience a substantial burden because of the treatments they receive as well as the burden of their chronic health problems. There has been increasing recognition of this issue, particularly in the UK and US. Objective: This article summarises the evolution of the concept ‘minimally disrup...

Objectives To evaluate the diagnosis and management of reflux and gastro-oesophageal reflux disease (GORD) in infants aged <1 year presenting to general practitioners (GPs). Design, setting and participants A nationally representative, prospective, cross-sectional survey of GP activity in Australia, 2006–2016 (Bettering the Evaluation And Care of...

Objective: To determine the frequency of general practice administrative encounters, and to determine whether they represent low value care. Design: Secondary analysis of data from the Bettering Evaluation and Care of Health (BEACH) dataset. Setting: 1 568 100 GP-patient encounters in Australia, 2000-01 to 2015-16. Participants: An annual na...

Objective: To determine the frequency of general practice administrative encounters, and to determine whether they represent low value care. Design: Secondary analysis of data from the Bettering Evaluation and Care of Health (BEACH) dataset. Setting: 1 568 100 GP-patient encounters in Australia, 2000-01 to 2015-16. Participants: An annual nationall...

Background: Online health information is particularly important for cardiovascular disease (CVD) prevention, where lifestyle changes are recommended until risk becomes high enough to warrant pharmacological intervention. Online information is abundant, but the quality is often poor and many people do not have adequate health literacy to access, un...

Introduction: The SKAI (Sharing Knowledge About Immunisation) project aims to develop effective communication tools to support primary health care providers' consultations with parents who may be hesitant about vaccinating their children. Aim: This study explored parents' communication needs using a qualitative design. Methods: Parents of at l...

Objective: To assess the efficacy of an interactive smoking cessation decision-aid application (pp) compared with a smoking cessation static information app on continuous abstinence. Design: Automated double-blind randomised controlled trial with 6 months follow-up (2014-2015). Setting: Smartphone-based. Participants: 684 participants (daily...

Objective: Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timefr...